title: Hybrid endolaparoscopic management of biliary tract pathology in bariatric patients after gastric bypass: case report and review of a single-institution experience.
abstract: Obesity is the major risk factor in cholesterol crystal and gallstone formation. After an Roux-en-Y gastric bypass, biliary duct dilatation can appear and gallstone formation can cause biliary duct obstruction or gallstone pancreatitis. Management of this clinical situation can be challenging and many approaches have been reported. Endoscopic retrograde cholangiopancreatography plays an important role in the management of biliary duct obstruction in these patients. However, a previous modified anatomy makes this procedure technically difficult. For these reason, we describe our single-institution experience in the management of biliary duct obstruction utilizing a hybrid approach combining laparoscopy and flexible endoscopy.
authors.affiliation: *The Bariatric and Metabolic Institute, Division of Minimally Invasive and Bariatric Surgery, Bariatric Institute †Department of Gastroenterology Advanced Therapeutic Endoscopy, Cleveland Clinic Florida, Weston, FL.
authors.forename: Ramon
authors.initials: R
authors.lastname: Vilallonga
authors.forename: Ronnie
authors.initials: R
authors.lastname: Pimentel
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Rosenthal
mesh_terms: D001662:Biliary Tract Surgical Procedures / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D042882:Gallstones / Q000209:etiology / Q000601:surgery; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*